Tough to Treat
Episodes
Neurophysiological Underpinnings of the Trigeminal System - Part 1
17 Nov 2022
Contributed by Lukas
In this short episode, Susan discusses the upper cervical region and its effects on the rest of the body: core, pelvic floor dysfunction, muscle recru...
Lumbosacral Pain Presentation - A Typical Clinical Pattern
10 Nov 2022
Contributed by Lukas
In this episode, Susan and Erica discuss a series of patients that all presented lumbosacral pain. Clinical pattern recognition is an important part o...
What To Do When Your Treatment Stops Working
03 Nov 2022
Contributed by Lukas
In this short episode, Erica discusses her perspective on what to do when your patient plateaus. We've all been there. The proverbial plateau. Your ...
Treating Knee OA The Smart Way
27 Oct 2022
Contributed by Lukas
In this episode, Erica and Susan discuss how to begin and progress treatment with a knee OA without exacerbating their symptoms. Knee pain can be qui...
The Gut-Brain Axis - Stress, Pain, and Balance
20 Oct 2022
Contributed by Lukas
Join Susan as she shares a segment from a course she teaches on GI Dysfunction. This clip is dedicated to the Gut-Brain Axis and why the complex int...
Shoulder and Arm Pain - What is Really the Driver?
13 Oct 2022
Contributed by Lukas
In this episode, Susan and Erica discuss how very old drivers can present in a novel situation, as well as why new drivers will appear if compensatory...
Hip Pain In A Golfer: Why It's Not Going Away
06 Oct 2022
Contributed by Lukas
In this short episode, Erica highlights the importance of center of mass by assessing a semi-competitive golfer with hip pain. He suffered an avulsion...
Racquet Sports & Back Pain: Why You Should Look At The Foot
29 Sep 2022
Contributed by Lukas
In this episode, Susan and Erica discuss a young squash player with long-standing low back pain. They highlight the importance of injury and moveme...
When You Should Tape and Why
22 Sep 2022
Contributed by Lukas
In this short episode, Erica gives her perspective on when and why you should tape. This is one of the most commonly asked questions in her practice a...
Low Back Pain: Regional vs. Movement System Considerations
15 Sep 2022
Contributed by Lukas
If it walks like a duck and quacks like a duck - it must be a duck, right? Low back pain is a descriptive term at best, indicating where symptoms pr...
Exercise Progression for the Tough to Treat Shoulder
25 Aug 2022
Contributed by Lukas
The shoulder can be tough to treat at times, right? It consists of many regions of the body and in order to design an exercise progression that g...
Hypermobility and Low Back Pain
11 Aug 2022
Contributed by Lukas
How do you rehab someone who is VERY hypermobile and suffers from persistent low back pain? And their driver is NOT the lumbar spine. This episode hi...
Exercise Progression For Neck Pain And Headaches
28 Jul 2022
Contributed by Lukas
This episode highlights exercise progression for a patient with neck pain and concurrent headaches. This elusive driver can often be lost when it com...
Hip Pain, Hypermobility, and a Subtle Driver!
14 Jul 2022
Contributed by Lukas
Working with a ballet dancer with hip pain, even with a very subtle driver, means continuing to look at the full movement system in its entirety! Reg...
Reframing The Narrative For A More Effective Assessment
30 Jun 2022
Contributed by Lukas
Can you find clues in your patient's narrative that will help you find the driver quicker? Make your assessment more efficient and save you time? Thi...
Choosing The Best Functional Movement For Your Assessment
23 Jun 2022
Contributed by Lukas
Success=picking the best functional movement to assess with your patient. Can you imagine shaving minutes off of your initial evaluation time? And...
Junior Golfer with an Unusual Source to his Knee Pain
16 Jun 2022
Contributed by Lukas
Erica and Susan discuss in this podcast how treating the left hip as well as the left side of the low back, got rid of this young golfer's knee pain. ...
Myth Busting - Rethinking Pregnancy Related Pelvic Girdle Pain
19 May 2022
Contributed by Lukas
There is usually a ten-year lag from published research to accepted practice in clinical arenas. Pelvic girdle pain in Pregnancy is no exception. Join...
Smart Exercise Progression
05 May 2022
Contributed by Lukas
What constitutes an effective and efficient exercise progression? How do you smartly move someone through a movement program targetting their driver? ...
Smart Exercise Progression
05 May 2022
Contributed by Lukas
What constitutes an effective and efficient exercise progression? How do you smartly move someone through a movement program targetting their driver? ...
CV joints and bladder urgency - is there a connection?
21 Apr 2022
Contributed by Lukas
Clients report urgency/frequency and are most often treated with medication and pelvic floor PT. When only a regional approach to the pelvic floor ove...
The Foot and Diaphragm- Their Connection To This Skier's Hip Pain
07 Apr 2022
Contributed by Lukas
What happens when you take away a compensation? Movement patterns change for starters. But what if these new strategies are not optimal for whatever a...
Persistent insertional tendonopathy - the importance of the systems approach
24 Mar 2022
Contributed by Lukas
The movement system is adaptable until there is maladaptation! Why is tendonopathy so difficult to treat? What if straight eccentric loading doesn't w...
Persistent Shin Pain-Where is the Driver(s)? Hint: Not the Lumbar Spine
24 Feb 2022
Contributed by Lukas
Can there be 2 drivers to someone's shin pain? Of course! What is the relationship between them? Are they directly connected? Is there some underlying...
The Psoas Triangle
10 Feb 2022
Contributed by Lukas
Differentials of common segment's neurology - Join us as we discuss the shared neurology of the T12/L1 region and how this can be a driver to anterior...
Designing Exercise Progressions For The Tough To Treat
27 Jan 2022
Contributed by Lukas
How do you design a sound, clinically reasoned exercise progression? Taking into account multiple drivers? If someone has low back pain, do you give t...
Persistent Pubic Symphysis Pain/Right Anterior Hip Pain
13 Jan 2022
Contributed by Lukas
10-20% of women with pelvic girdle pain in pregnancy will persist into the post-partum era. Join us as we share a discussion on the history that led t...
Does the Elbow Always Drive Elbow Pain?
30 Dec 2021
Contributed by Lukas
A fall on an outstretched elbow (FOOSH) with resulting elbow pain. Not your typical overuse or mechanical injury common to this region of the body. Wh...
A Case of Lateral Hip Pain
15 Dec 2021
Contributed by Lukas
Consideration of lateral hip pain requires a thoughtful clinical reasoning process to discover the physiology/movement patterns as well as neural con...
5 Symptomatic Regions Of The Body With One Main Driver- Part 2
02 Dec 2021
Contributed by Lukas
After listening to Part 1 of this case (episode 109), how would you design an exercise progression? Remember you need to find the driver first. Design...
5 Symptomatic Regions Of The Body With One Main Driver
18 Nov 2021
Contributed by Lukas
What happens when you have 2 regions of the body that when treated together give your patient the best movement options and no pain? But, when they ar...
Complex Persistent Pain - Part 2 Where is the driver?
04 Nov 2021
Contributed by Lukas
Do you have thoughts on the driver from part 1? In part 2 we take you through the discovery and clinical reasoning parts to determine the primary driv...
Complex Persistent Pain - Part 1 Where is the driver?
21 Oct 2021
Contributed by Lukas
We always discuss history and relevant events. In this episode we take a deeper dive into all aspects of the story in the BPS lens. Join us for our di...
Persistent Unsolved Hip Pain
07 Oct 2021
Contributed by Lukas
Does all hip pain require strengthening? Of course not! And certainly not in this persistent case. This episode shows you the importance of digging de...
Nociplastic Pain and a Visceral Driver
16 Sep 2021
Contributed by Lukas
What do you do when a client presents with a myriad of LQ symptoms without a clear regional driver? Look to the history and keep asking questions even...
"X" Marks The Spot-Navigating The True Source Of Shoulder Pain
26 Aug 2021
Contributed by Lukas
Save yourself time by learning how to find the driver quicker. This is the case of a neck driven shoulder- but not in the way you think! Do all should...
Complex Ankle Sprains - What is Missing?
12 Aug 2021
Contributed by Lukas
Ankle sprain rehab can seem so straight forward - decrease swelling, improve ROM and strength - right? Wait, why are a good number not improving and r...
Treatment Progressions for the Tough To Treat- Clinical Pearls
15 Jul 2021
Contributed by Lukas
Clinical pearl alert! This episode tells the story of 3 patients and their treatment progressions. Typical symptoms but atypical drivers. What types o...
SI Joint Pain - An Updated Approach
01 Jul 2021
Contributed by Lukas
Here is the clinical story of a client that is presenting with pain/sensitivity in the area of the (R) posterior pelvis. In this episode we discuss wh...
What To Do When Your Patient Plateaus
17 Jun 2021
Contributed by Lukas
What do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatm...
What To Do When Your Patient Plateaus
17 Jun 2021
Contributed by Lukas
What do you do when a patient plateaus? Doesn't improve? Join us for our first Q and A broadcast on how to clnically reason through a patient's treatm...
Clinical Pearls for the Shoulder-Understanding the Connections in the Upper Quarter
03 Jun 2021
Contributed by Lukas
Join us for a special episode on the shoulder. This is a re-release of one of our most popular episodes to date. As a bonus, we present 3 case studies...
The Key To Functional Movement Assessments
20 May 2021
Contributed by Lukas
Join us for Part 2 of our discussion on functional movement patterns. How can you make your assessment more efficient and reliable? We discuss what to...
"Why Does My Foot Hurt? What's Going On?"
05 May 2021
Contributed by Lukas
Why would someone who is 3 months post fibular fracture get worse after a basic theraband ankle exercise? Not everyone needs inversion and eversion th...
Musculoskeletal Driver of Hip Pain in a Young Dancer
22 Apr 2021
Contributed by Lukas
When working with young athletes it is easy to have early success in treating the acute or subacute injuries. What happens when the latest injury reve...
The Knee and its Relationship to the Whole Person
08 Apr 2021
Contributed by Lukas
How does the knee affect so many parts of the body? Join us for this discussion on this important intermediate joint of the lower kinetic chain and ho...
Chest Pain In An Endurance Athlete
26 Mar 2021
Contributed by Lukas
Does chest pain raise your eyebrows? Red flag? Or wild goose chase? This case is an insight into a classic endurance athlete and how his past injuries...
Shoulder Pain and Distal Drivers
11 Mar 2021
Contributed by Lukas
This episode features a case of shoulder pain with unusual drivers due to their distal proximity. Join us as we discuss this interesting clinical case...
Not Your Ordinary Knee Patient
25 Feb 2021
Contributed by Lukas
What do you automatically think when someone tells you they have knee pain? It's worse with walking SW and walking FW. And the patient cannot sleep si...
Thoracic Mobility Beyond The Breath
22 Feb 2021
Contributed by Lukas
In this episode Susan and Erica discuss the many ways the thorax can be the driver for a multitude of upper and lower extremity issues. This important...
Ankle fracture rehab - what is missing?
28 Jan 2021
Contributed by Lukas
As health care providers and rehab professionals, there is the story that ankle fracture rehab is simple. Makes sense right? A regional intervention o...
Does Hip Pain Always Come From The Hip?
14 Jan 2021
Contributed by Lukas
When someone complains of persistent hip pain, what do you think? Is the source the hip? It may be the pain generator but at this point, is the primar...
The Shoulder Is Connected To Everything
31 Dec 2020
Contributed by Lukas
Join us for a fun discussion on the relationship of the shoulder to the rest of the body. Learn about all the connections between the shoulder, the cr...
Double Vision Post Partum, Cause or Effect?
17 Dec 2020
Contributed by Lukas
Tune in for an interesting discussion on a woman presenting with complaints of double vision 8 months after the birth of her third child. A coincidenc...
Neural Tension and Beyond
03 Dec 2020
Contributed by Lukas
Can neural tension be responsible for a tight hip? Absolutely! Would you believe that neural tension in the right hip can be responsible for left hip ...
Neck Pain/Back Pain - Where Do You Start?
19 Nov 2020
Contributed by Lukas
Finding clients with subjective pain in the low back and cervical region is not an uncommon presentation. The bias is to treat the most acute region a...
How To Master Functional Movement Assessment
05 Nov 2020
Contributed by Lukas
Functional movement re-patterning is the key to changing someone's movement strategy. But how do you choose the right one, so you are more organized a...
Training the Tough To Treat Shoulder
22 Oct 2020
Contributed by Lukas
How many neck problems are really disguised as shoulder issues? A lot actually! It is extremely common to overwork some of those small muscles of the ...
Pelvic Pain - Things Are Not Always As They Seem!
08 Oct 2020
Contributed by Lukas
Don't let the diagnosis be your guide, listen to the whole story, and be curious outside of pattern recognition. Is the original thought about the cas...
Elite Soccer Player with Low Back Pain
24 Sep 2020
Contributed by Lukas
Why can't this athlete get rid of his low back pain? "Running- I have no problem with" "Lateral-side to side-movements really aggravate me". " Why?" H...
Full Squat vs. Partial Squat?
10 Sep 2020
Contributed by Lukas
A recent article on various depths of squats revealed information that a full squat is more beneficial than partial squats in improving function and p...
Medial Elbow Pain and Tingling/Numbness
27 Aug 2020
Contributed by Lukas
Another case with elbow issues! This case involves neural tension, pins/needles, and catastrophization. What is the best way to begin to work with som...
Demystifying Tennis Elbow
13 Aug 2020
Contributed by Lukas
Tennis elbow is one of those conditions that is extremely frustrating for both patient and practitioner alike. It turns into a persistent problem very...
Runners With Recurrent Knee Pain-Finding The Driver
30 Jul 2020
Contributed by Lukas
We all have patients for whatever reason, who always come back for the same problem over and over again. Even if they haven't been back for over 5 yea...
Exercise progressions for the tough to treat foot
16 Jul 2020
Contributed by Lukas
Your client has low back, hip, or pelvic girdle pain as examples, and you determine that the foot is the driver for these symptoms. What types of exer...
Are patients really good historians?
02 Jul 2020
Contributed by Lukas
What happens when your patient/client forgets to tell you key pieces to their history? It happens alot - and sometimes can have great impact on our de...
Does scapula stabilization always work?
18 Jun 2020
Contributed by Lukas
This episode is about a weightlifter who suffered a T1 avulsion fracture, had surgery to remove the fragment and still had symptoms. Why? Because the ...
Post-partum back and abdominal pain - what is the priority?
10 Jun 2020
Contributed by Lukas
Let's continue with the 3 powerful questions in determing the direction and priority of intervention. Immediate post-partum females can present with a...
Herniated disc? Or Fear of sitting?
21 May 2020
Contributed by Lukas
What do you do when your patient tells you she has not sat for 9 months? And furthermore, a healthcare practitioner told her this! How do you "debunk"...
Pelvic girdle pain and the BPS approach
07 May 2020
Contributed by Lukas
What are your three powerful questions that you use with your clients? Join Erica and I as we talk about working with clients from a full biopsychosoc...
I Hurt Everywhere
23 Apr 2020
Contributed by Lukas
Who hasn't heard this? This patient was seen in the clinic once just prior to the COVID-19 crisis and then progressed virtually from there. When someo...
Chronic Achilles Insertional Tendonosis
09 Apr 2020
Contributed by Lukas
What do we really know about the achilles tendon and the various forms of tendonosis? What do you do when the eccentric exercise programs outlined in ...
Higher Load Exercise Progressions and Secondary Drivers
26 Mar 2020
Contributed by Lukas
Success-your patient's original symptoms are gone and you are moving along with their program. They are progressing to higher loads, higher impact as ...
Foot numbness - differentials and interventions
12 Mar 2020
Contributed by Lukas
Have you ever had a patient where the story and the problems they were having were easy to solve, but your thoughts were - "It can't be this simple?" ...
5 years Post-Partum with Persistent Low Back Pain
27 Feb 2020
Contributed by Lukas
This patient has had low back pain since she was a child. She has coped well until the birth of her own children. The innate response to threat here i...
Heel pain - is it always a MSK issue?
13 Feb 2020
Contributed by Lukas
What goes through your mind in pattern recognition when you hear the word heel pain? What do you begin to think - and then their story actually does n...
Butt pain-where's it coming from? The low back? Hip? Pelvis?
30 Jan 2020
Contributed by Lukas
One main symptom but 3 potential drivers. Is this person's glute pain coming from his hip? Low back? Pelvis? In this episode Erica and Susan discuss t...
063: Hip arthritis! Update from #37
16 Jan 2020
Contributed by Lukas
What do you do when you run into a true hip joint limitation with persistent pain. altered patterns of movement and loss of the closed pack position? ...
062: Persistent shin pain & a lateral shift-implications for gait
02 Jan 2020
Contributed by Lukas
Is a lateral shift a reaction to an irritated nerve root? Or is it part of a functional scoliosis? Or neither? This patient experienced persistent rig...
061: Back pain, stiffness and the search for the cause!
19 Dec 2019
Contributed by Lukas
What happens when you are an athlete and have endured many injuries in your life that have all healed, and now you have a back injury that is stubborn...
060: Changing symptoms- a motor control problem or something else?
05 Dec 2019
Contributed by Lukas
We have all been through this-as providers or patients. One day your low back hurts on the right, the next day it's the left, and 2 days later it's yo...
059: Stress urinary incontinence - muscle weakness or load transfer?
14 Nov 2019
Contributed by Lukas
What flashes through your mind with a diagnosis of SUI - muscle weakness? That is certainly one hypothesis! Listen in on this episode where we explore...
058: Foot pain of questionable origin
31 Oct 2019
Contributed by Lukas
Failed epidurals, back surgery and you still have buttock pain along with foot pain. Why? We all know back surgery is not always the answer, but why w...
057: Elbow pain or cervical?
17 Oct 2019
Contributed by Lukas
Join us on this podcast as we work through the differentials of this complex post-partum client with the onset of elbow joint pain. Issues that have b...
056: Is this patient tough to treat?
03 Oct 2019
Contributed by Lukas
How does someone who has had 4 sessions of PT somewhere else become complex? The answer: She got the wrong treatment. And what happened? It sensitized...
055: Back pain or leg pain - why is it getting worse?
19 Sep 2019
Contributed by Lukas
Explore the narrative of this client with persistent hip and leg pain for over 20 years. In this episode we explore the behaviors and mitigating facto...
054: Leaking and Running - A solution
05 Sep 2019
Contributed by Lukas
You have not run in over a year because of a foot and hip injury. Finally, it's all coming together-you have less hip pain and your foot pain has been...
053: Is an overactive TFL a poor movement strategy?
22 Aug 2019
Contributed by Lukas
Your patient cannot sit and cannot squat in the gym without lateral hip pain. They believe it is their overactive TFL. But is it the cause of the prob...
052: A shoulder or a neck problem - what is important to the patient?
08 Aug 2019
Contributed by Lukas
Shoulder pain - or neck pain? Does it really matter to the intervention? What does the client believe and expect? How do you manage client expectation...
051: Is it really the nerve root?
25 Jul 2019
Contributed by Lukas
Searing shin pain, low back pain, night sweats, unable to sleep or walk-is it the disc? The nerve root? A sensitive nervous system? Or something else?...
050: Finding the real story through the narrative
04 Jul 2019
Contributed by Lukas
Do you ever wonder if there is a better way to evaluate the complex patient? What do you do when the body diagram is full with a long history? I thi...
049: Game Changing Exercise Progressions
20 Jun 2019
Contributed by Lukas
Do you want better outcomes with your patients? What do you do when a patient has plateaued? Or they're not improving as fast as they should be? One o...
048: Complicated thigh numbness-is it really the nerve?
06 Jun 2019
Contributed by Lukas
What happens when someone's thigh goes numb and does not go away? The nerve is obviously angry but what is the driver? What could possibly cause someo...
047: Fear avoidance with low back & pelvic pain
23 May 2019
Contributed by Lukas
Low back pain - the need to stretch and fear avoidance complications. What happens if the movement or postures you believe to be good are really probl...
046: Leg pain and peripheral nerves
09 May 2019
Contributed by Lukas
What happens when someone suffers a traumatic injury, then lives with it for 8 months? Listen to this episode and find out. Susan and I discuss a form...
045: Female with bilateral hip pain? Is it really a hip joint problem?
25 Apr 2019
Contributed by Lukas
Join in on this differential diagnosis and use of evidence to help determine the underlying cause and progressive movements to help this very strong a...
044: Dancer with Pelvic Pain-Is it Really the Pelvis?
11 Apr 2019
Contributed by Lukas
Does this dancer with persistent left-sided pelvic girdle pain need to have her SI joint manipulated all the time? The answer is an obvious no! In thi...
043: Neurogenic pain and complex metabolic issues
28 Mar 2019
Contributed by Lukas
This episode features a gentleman with complex metabolic issues, neurogenic pain and an interesting cross-section of mechanical MSK issues. Join us as...
042: Complex issues with pain and fear avoidance
14 Mar 2019
Contributed by Lukas
Tough To Treat Masterclass: In this episode we have guest PT, Alaina Newell, who presents us with one of her tough male patients with a primary compla...
041: Not Your Ordinary Hip Problem
28 Feb 2019
Contributed by Lukas
What do you do when your patient tells you that she hurts everywhere? In this episode, Susan and I discuss a patient with an EXTENSIVE injury history ...